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Congenital Muscular Torticollis

more about Congenital Muscular Torticollis

"Wry neck"

  • Torticollis is an abnormal positioning of the head.

  • Head positioned in the characteristic fashion:
    1. The head is tilted toward the affected side.
    2. The chin is turned away from the affected side.
    3. Because of this, the child appears to be looking up and to the side; the child looks away from the side that is affected by the problem.
    4. Parents usually notice that a baby will not look in one particular.
  • Neck mass on the affected side:
    1. The mass is usually first noticed soon after birth, but sometimes may not be found until several weeks after birth, when the infant's neck begins to elongate.
    2. The mass is firm and not tender, and increases in size for several weeks, then begins to slowly disappear over several months.

  • The cause of congenital muscular torticollis is not known.  However, there are several prominent theories:
    1. Injury to the neck during the delivery process
    2. Intrauterine pressure on the neck due to positioning in the uterus (womb)
    3. Abnormalities of blood vessels and blood flow in the fetus
    4. These abnormalities result in the formation of a small scar inside the muscles of the neck.  It is this scar that is felt as the neck "mass."  The scar tissue prevents the muscle involved from working normally.

  • Diagnosis is made on the basis of physical examination and history; no tests are needed.
  • However, because some children with this condition will also have other musculoskeletal problems, x-rays of other parts of the body may be required.
  • If the neck mass fails to disappear, an ultrasound may help confirm that other problems are not present.

  • Slightly more common in males than in females
  • About 10% of babies with congenital muscular torticollis also have a family member with torticollis.

  • The mainstay of treatment is stimulating the infant to turn his/her head toward the affected side.  This will stretch out the scar tissue in the involved muscle.
    1. Usually, this is accomplished by placing the baby in a crib with all the toys and bright objects on the affected side.  This forces the infant to turn the head to look at the interesting things in his/her environment.
    2. Some range-of-motion and stretching exercises are sometimes also used.
    3. If done consistently, these interventions will work in nearly all affected babies.
  • The small number of children in whom the condition persists past the first birthday, or in whom the loss of range-of-motion is profound, require surgery to remove the scar tissue and return full function to the affected muscle.

  • Most infants will do very well and have no future problems.
  • A small number may later develop an abnormality of their ability to tilt the head, a difference in the size and shape of the two sides of the neck, or a slight degree of scoliosis.
  • The risk of these complications does not appear to be affected by the kind of treatments used (stretching versus surgery).

  • See your pediatrician immediately.

more about Congenital Muscular Torticollis

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